Sue and Sue (1999) include as a final chapter in
their textbook “four other groups who have experienced systematic
marginalization and oppression by the dominant culture” who are included
“because they have received the most interest from the American Psychological
Association and the American Counseling Association.” (p. 304).Even though they state that “the inclusion
of these groups in a single chapter in no way implies that we view them as
‘less important,’ but rather that we have a greater familiarity with issues
related to persons of color” (p. ix), one cannot help but interpret that these
groups are something of an afterthought to the multicultural discussion.However, there is one culturally different
minority that does not appear, even as an afterthought, in Sue and Sue.
This equally marginalized, and often
invisible, group comprises somewhere between 3% - 10% of the United States
population.(Ettner, 1999).They are the transgendered – persons whose
gender identity and/or biological sex in some way transgresses the societal
norm.

What is it about gender that keeps us from knowing
and serving the transgendered, that makes even the discussion of gender
nonconformity in our society so difficult?Who are the transgendered among us?Can they be considered both culturally distinct and a marginalized and
oppressed group?What are their special
needs and issues, and those of their family and friends, when interacting with
the mental health system?And, what are
the added complications of gender variance and a minority ethnicity?These are the questions I will attempt to
address in this paper.

I am also the partner of a transgendered person (John/Jan) who is in
the process of male to female (M2F) transition.Throughout this paper, when I feel that our experiences serve to
illustrate a point, I will include parts of our personal story.I will set these apart in italicized
paragraphs to distinguish between my research and my personal feelings and
experiences.

What is
“Transgender”?

The relative invisibility
of the transgendered in our society is directly related to our strict adherence
to a binary understanding of sex and gender.“Western culture is deeply committed to the idea that there are only two
sexes.Even language refuses other
possibilities.”(Fausto-Sterling, 1993,
p. 20).We see “male” and “female” and,
for most of us, any exceptions to those categories seem so profoundly “other”
that they actually serve to reinforce the binary system.As Kate Bornstein (1995) says, “The choice
between two of something is not a choice at all, but rather the opportunity to
subscribe to the value system which holds the two presented choices as mutually
exclusive alternatives.Once we choose
one or the other, we’ve bought into the system that perpetuates the binary.”
(p. 101).Thus, if we are not going to
buy into the binary, if we want to see the transgendered for whom they really
are, we need to understand the extent of the diversity around us.

Even without adding the more ambiguous layer of
“gender” to the discussion, the question of physical sex leads to an amazing
diversity.According to scholar Steven
Whittle (as cited by Mollenkott, 2001), “Currently medicine recognizes over 70
different inersex syndromes, and one in every 200 children will be born with
some sort of intersex matrix.” (p. 45).The actual number of intersexed individuals is difficult to determine,
since the tendency, historically, has been to hide such a condition.Kirk and Rothblatt (1995) appear to be in
the minority when they state “Inter-sexual problems such as
pseudohermaphroditism or Kleinfeler’s syndrome are very uncommon as well and
will generally be diagnosed quite early in life.” (p. 10).In her seminal 1993 essay, Fausto-Sterling
stated that about 4% of human births are intersexual.Mollenkott (2001) cites Rothblatt as another source of the 4% figure.(Perhaps Rothblatt’s opinion has changed
since the 1995 book, as 4% doesn’t sound “very uncommon” to me.)Between 1993 and her 2000 revisit,
Fausto-Sterling led at Brown University the first systematic investigation of
the available data and concluded that 1.7% is a more accurate estimate.1.7% or 4% or somewhere in-between, this is
not an insignificant population.Why do
so many of us not know they exist?

In 1993 I was an infant in the complex gender world.I had discovered a few years earlier that
one of my best friends was gay, and had started to investigate the realities of
that world and to transform my homophobic tendencies.I was only vaguely aware of my husband’s cross-dressing, and it
was not yet a subject that we could discuss.But one spring day our issue of The Sciences arrived with the tantalizing cover article “The Five
Sexes.”(Fausto-Sterling, 1993).I read
it, re-read it, put it away for a few weeks and thought about it, got it out
again, copied it, and sent it around to several people for comments.It was a revelation, but my main response
was a feeling of betrayal.If as many
as 1 in 25 people are not by nature either male or female, why had I never been
told?Where was the discussion in my
biology class?In health?In psychology?Who are these people?Surely I must know a few.Why
the conspiracy of silence?

I tucked copies
of the article away in several of my files, afraid to lose track of it, afraid
of forgetting this tenuous introduction to an entirely new reality.I didn’t know why the article affected me so
much, but I knew it was a beginning…

The concepts of gender,
gender assignment, gender identity, gender expression, and gender attribution
add considerable complexity to the discussion.Gender is a socially
determined construct – the association of particular qualities of behavior and
societal roles with biological sex.Gender assignment is a medical/legal
determination: it’s the male or female designation on your birth certificate,
the legal determination of whom you are allowed to marry, whether or not you
are required to register for the draft.Because of physical appearance at birth, or occasionally because of
genetic testing, a person is assigned a legal status that allows only male or
female, and nothing in-between.Gender identity is the association of
self with maleness or femaleness, or in the case of trans-gender, with
something not entirely one or the other.According to Fausto-Sterling (2000), “Gender identity presumably emerges
from all of those corporeal aspects [sex at cellular, hormonal and anatomical
levels] via some poorly understood interaction with environment and
experience.”(p. 22).Ettner (1999) concludes from research done
by T.G. White in 1997 that gender identity is a process that begins in utero
and is consolidated by three years of age.Gender expression is the
outward expression of gender roles to society; the “performance of
gender.”Gender expression normally
determines the gender attribution
assigned to us by society.In the words
of psychologist Suzanne Kessler (as quoted in Fausto-Sterling, 2000), “In the
everyday world gender attributions are made without access to genital
inspection. … What has primacy in everyday life is the gender that is
performed, regardless of the flesh’s configuration under the clothes.” (p. 22).

Final layers of complexity are sexuality and sexual
orientation, encompassing a wide range of possibilities for anyone at any point
on the gender spectrum.“The matter of
sexual orientation represents an ongoing concern for transgender individuals
and those providing specialized support care, party because the terms sex,
sexual orientation and gender identity are interchanged erroneously.”(Israel & Tarver, 1997, p. 43).“Some transgender individuals may not have
crystallized a sexual orientation during puberty, and may feel uncertainty or
reexplore their sexual orientation simultaneously with exploring
gender-identity issues.”(p. 45).It can even be difficult to draw a line
between “gay/lesbian/bisexual” and “transgender.”“Since binary gender insists that ‘real men’ desire only women
and ‘real women’ desire only men, homosexuals and bisexuals really do ‘trans’ or cross over the gender
boundary by loving people of their own gender.”(Mollenkott, 2001, p. 72).As Erhardt (2002) says, “Human reality, however, resists being forced into
neat little either/or boxes.The
existence of intersexuals belies the biological male/female dichotomy.Some people are asexual, bisexual or
omnisexual, so I wish society, even queer society, which you would expect to be
a bit less sexually rigid, would quit trying to force us into hetero/homosexual
boxes.I see both gender identity and
erotic orientation existing on a spectrum as well.”

According to Fausto-Sterling (2000), “The medical and
scientific communities have yet to adopt a language that is capable of
describing such diversity.” (p. 22).The umbrella of “transgender” is often used, as I will use it here, to
describe the full range of people who transgress the bipolar gender system.According to Mollenkott (2001), “the term
has been extended to include intersexuals, transsexuals, cross-dressers, drag
queens and kings, androgynes, and anyone else who feels ‘othewise’ from
society’s gender assumptions.” (p. 40).Mollenkott introduces the term ‘omnigendered’ and Miller (1996)
‘polygendered’ into the mix to indicate individuals whose gender identity is
either too expansive or too fluid to fit into the any of other categories.Importantly, Mollenkott along with Israel
and Tarver (1997) remind us that not all who would fit these definitions would
agree on the use of the terms.

Most of these terms are in common enough usage that
their definition in this paper is not necessary (see Mollenkott (2001), Ettner
(1999), Israel & Tarver (1997), or Miller (1996) for more discussion).I will, however, discuss the use of
“transsexual” and “transgenderist.”Ordinarily, transsexual is used to refer to people who have undergone,
or plan to undergo full sex reassignment, including genital reassignment
surgery.Transgenderist, and
occasionally simply “transgender,” can be used to refer to those whose core
identity is transgender.According to
Mollenkott, they are those who live in role part-time or full-time as members
of the “opposite” gender, “sometimes using hormones and cosmetic surgery, even
castration, but they do not seek gender reassignment surgery.Occasionally they self-identify as
bi-gender.” (p. 64).I will use the
term “transgenderist” in this sense, to distinguish from my broader use of
“transgender.”Interestingly, the
attempts to distinguish between “transsexual” and “transgender” become less
clear as social acceptance grows and options increase.Consider the ambiguity and overlap in the
following definitions:

Transsexuality is a
function of the binary gender construct, because when only two alternatives
exist, a person is forced to choose one and then do whatever is necessary to
present herself or himself in a way that is culturally appropriate.(Mollenkott, 2001, p. 51)

Transsexualism, in
fact, is one distinctly twentieth-century manifestation of cross-dressing and
the anxieties of binarity, an identifiable site, inscribed on the body, of the
question of the constructedness of gender.(Garber, 1992, p. 15)

The term ‘transexual’
is used to describe persons who are either ‘pre-op’ or ‘post-op’ …
Transsexualism is not a surgical product but a social, cultural and
psychological zone.(Garber, 1992, p.
106)

Transsexuals, people
who have an emotional gender at odds with their physical sex, once described
themselves in terms of dimorphic absolutes – males trapped in female bodies, or
vice versa.As such, they sought
psychological relief through surgery.Although many still do, some so-called transgendered people today are
content to inhabit a more ambiguous zone.(Fausto-Sterling, 2000, p. 22)

[The transgendered are]
people who are challenging the obligatory two-gender system by blending public
features of maleness and femaleness, or by accepting bits and pieces of the
surgical options without “going all the way,” or by doing both.People who are transgender disrupt gender in
two ways:They refuse to provide the
cues that would permit them to be regarded as either male or female.And they treat biological signs of gender
(including genitals) as bodily ornaments – neither more nor less elective than
a face-lift.(Kessler, 1993)

The DSM-IV term for all of the
above is “gender dysphoria,” which I address last and somewhat reluctantly
because many feel the inclusions of “gender identity disorders” in the DSM-IV
serves only to stigmatize individuals.“The DSM-IV-TR (text revision, August, 2000), like its predecessors, may
too easily be interpreted to deny the existence of healthy, well adjusted
gender variant people and to provide a justification for discrimination against
them.”(GIDreform, 2002).For transgender advocacy groups, “it is time
for diagnostic criteria that serve a clear therapeutic purpose, are
appropriately inclusive, and define disorder on the basis of distress or
impairment and not upon social nonconformity.” (GIDreform).As Bornstein (1995) says, “I was gender dysphoric for my whole life
before, and for sometime after my gender change – blindly buying into the
gender system.As soon as I came to
some understanding about the constructed nature of gender, and my relationship
to that system, I ceased being gender dysphoric.”(p. 119).

Lastly, how many transgendered are
out there?We have already seen that
somewhere around 2-4% of the population are intersexual.According to Ettner (1999), a “conservative
estimate is that 3-5% of the United States population has some degree of gender
dysphoria.Others claim that 8-10% is
more precise.” (p. 28).Israel and
Tarver (1997) give a more conservative estimate of 3% of the general
population.Most sources claim
approximately equal numbers of male to female (M2F) and female to male (F2M)
transgendered or transsexual individuals, although several indicate that M2F
individuals in our society are more visible, making true estimates of the
numbers difficult.Fewer F2M’s seek sex
reassignment surgery, where the complexity, cost and success rates are not
equal to M2F surgery.

Considering that many transgendered
individuals do not completely come to understand themselves as such until well
into their adult lives, and that intersexuals often never know about their
condition or discover it only when they attend a fertility treatment clinic
later in life (Steven Whittle as cited in Mollenkott, 2001), I agree with
Mollenkott when she concludes:

That means that
anybody among the vast majority of us could conceivably be atypical and
therefore intersexual and transgender without even knowing it – a marvelous
reason for relaxing our rigid gender expectations.(p. 44).

A Brief History

Understanding some
of the history of society’s interaction with the transgendered is a necessary
background for working with these individuals, their family, friends and
co-workers.

Despite the strident assertions of
some of society’s “gender defenders” (For example, see Stanfield (2001), who
says “The causes of such imbalances are varied – from stress and the drugs
prescribed to pregnant women to environmental pollution – but the essential
point is that human interventions are disrupting the natural dimorphic brain
patterning of male and female infants.”), intersexuals and the transgendered
have been a part of society throughout history.Transgendered expression dates back to the beginning of time and
documentation of such practices at least to the Old Testament. (Ettner, 1999)I will discuss other societies’ responses
further in the section Transgender and
Other Cultures, but will briefly discuss the Western European perspective
here.

Western European society has been
heavily invested in binary gender rigidity at least since the Middle Ages.“In Europe, a pattern emerged by the end of
the Middle Ages that, in a sense, has lasted to the present day:hermaphrodites were compelled to choose an
established gender role and stick with it.The penalty for transgression was often death.”(Fausto-Sterling, 1993, p. 23).Transgendered persons were forced to hide
and only acknowledge by society in rumors, derision, and sensationalized
stories, although the penalties were generally more severe for women than for
men.For example; sensationalized (but
unsubstantiated) rumors of a female Pope Joan who was killed when giving birth
made it obvious that she was a woman, or the burning at the stake of Joan of
Arc for masquerading as a man, vs. the general notoriety but acceptance of
James I for his flamboyance and overt bisexuality, or the “sorrow” and “anger”
with which his enemies pointed to the “poor judgment” of Lord Cornbury
(Governor of New York and New Jersey from 1702-1708) for dressing as a
woman.(Garber, 1992).

The twentieth century has ushered
in great change in how the transgendered cope in society, with huge advances in
medical care and much interest from the psychiatric and psychological
professions.Unfortunately, until
recently most attitudes have remained in the Middle Ages.“Most of us have grown up in a land that
looks upon cross dressers and transsexuals as psychiatric casualties.”(Richard Docter, in foreword to Miller,
1996, p. xix).

According to Garber (1992),
"Transsexual surgery has been performed since 1922." (p. 15).However, it was Dr. Harry Benjamin who
brought both the medical and psychological treatment of the transgendered into
the national consciousness.Dr.
Benjamin saw his first transgendered patient in 1948, and by 1965 had seen
three hundred and seven transsexual patients.(Ettner, 1999).His most famous
patient, Christine Jorgensen, made headlines in 1953.(Garber, 1992).He
published a book, The Transsexual
Phenomenon, in 1966 that broke the silence for thousands of
transsexuals.(Ettner).Dr. Benjamin lent his name to the he Harry
Benjamin International Gender Dysphoria Association (HBIGDA) and the associated
Standards of Care (HBIGDA, 2001), which are internationally accepted standards
that remain the primary reference for the medical and mental health treatment
of gender identity disorders.

Controversy over the transsexual
phenomena exploded into the news with the publication and ensuing debate about
Green and Money’s Transsexualism and Sex
Reassignment in 1969.Money, an
influential Johns Hopkins university gender specialist “believed that gender
identity is completely malleable for about eighteen months after birth.Thus, he argued, when a treatment team is
presented with an infant who has ambiguous genitalia, the team could make a
gender assignment solely on the basis of what made the best surgical
sense.”(Fausto-Sterling, 2000, p.
20).He approached gender dysphoria as
a psychological pathology resulting from inadequate early gender identity development.Money’s ideas came into question as more
research, along with transgender activism, moved the prevailing attitude
towards the belief that gender identity development has both biological and
environmental components.“The
revelation of cases of failed reassignments and the emergence of intersex
activism have led to an increasing number of pediatric endocrinologists,
urologists and psychologists to reexamine the wisdom of early genital surgery.”
(p. 21).

By the late 1970’s, society had
Renée Richards, Jan Morris, and several other famous transsexuals to
contemplate.However, throughout the
1970’s and into the 80’s, “Many people who sought psychiatric help for their
gender condition, and the inevitable depression that resulted, were
involuntarily committed.”(Ettner,
1999, p. 45).There was still much
controversy and individuals willing to “go public” were subject to extreme
prejudice.In the spring of 1979, Johns
Hopkins Hospital stopped performing sex-reassignment surgery because research
by Dr. Jon K. Meyer failed to show objective improvement in patients’
lives.However, this conclusion was
successfully challenged in 1980 because of multiple flaws in his research
methodology and conclusions, and the value-laden nature of the
investigations.(For example, patients
were assigned a quantitative score of (minus 1) if they cohabitated with a
person of the “non gender appropriate sex.”)(Ettner).

After a
considerable thought and several previous attempts to “try on” various women’s
names, my partner selected Jan Renée as the name to use during transition and
which she will eventually make her legal identity.At the time, the notion wasn’t a conscious one, but we are both
now delighted to think of the name as a nod to the courageous Jan Morris and
Renée Richards, who allowed their very public stories to blaze the trail.

Not until the
1990’s did the general view of the transsexual change from the perspective that
the condition was associated with an underlying or coexisting psychiatric
disorder.A landmark study was
conducted by Cole, O’Boyle, Emory and Meyer in 1997 retrospectively of 435
gender dysphoric individuals and concluded that transsexualism “is usually an
isolated diagnosis and not part of any general psychopathological
disorder.”(Study as referenced in
Ettner, 1999).“Some European laws have
been changed to reflect this new recognition that transsexuals are born, not
made, and as such deserve medical care and legal protection.We in the United Sates have not followed
suit, as yet.”(Ettner, p. 57).

Currently, the subjects of
cross-dressing, transgender, and transsexualism are very much in the public
eye.“Why have cultural observers today
been so preoccupied with cross-dressing?Why is it virtually impossible to pick up a newspaper or turn on the
television or go to the movies without encountering, in some guise, the
question of sartorial gender bending?On American television, talk shows have had a field day with the
topic."(Garber, 1992, p. 5).But, it is the transgender community itself
that is taking up and shaping the discussion.“Many nontranssexual professional academics are beginning to catch on to
what we transsexuals have know for a long time:Transsexuality encompasses a fascinating, complex set of
phenomena that poses some radical questions about that way sexuality, gender,
identity, and desire are instituted and maintained.”(Susan Stryker, as quoted in Israel & Tarver, 1997, p.
241).“We’re moving from perverts to
experts in that venue [TV talk shows], those of us who are speaking out,
telling our stories.”(Bornstein, 1995,
p. 241).And they are calling for
change:“The disproportionate number of
essays in this addendum that address the need to depart radically from the
existing standards of care endorsed by HBIGDA underscores both the depth of
feeling on this issue in the transsexual community as well as the seriousness
of the situation.”(Stryker in Israel
& Tarver, p. 244).

Society would do well to listen to
this voice from the margins.As Miller
(1996) reminds us, “the minority of any group or society is the growing edge of
that society, its conscience, and its spiritual teacher.”(p. 156).

Transgender, A
Culture?

The subject of
this Capella University course is counseling the culturally different.Therefore, we must examine whether the
transgender community can be considered a culturally different group.My thesis is that they can, and I will
attempt to demonstrate this by looking at two different criteria: society’s
response to the transgendered, and transgender identity development.

Society’s Response:

Sue and Sue
(1999), observe, “The sociopolitical dynamics related to the treatment of
marginalized or oppressed groups in our society share many similarities.Prejudice, stereotyping, and discrimination
and their negative effects on these groups operate from a common foundation with
frightening effects.”(p. 304).Therefore, they assert that other groups,
such as gays and lesbians, the elderly, and women may be considered “culturally
distinct” because of the attitudes, isolation and oppression that they may
experience from society, and the ways they may band together to endure or fight
this oppression.The transgendered are
another such group.In addition, in
looking at the “anatomy” of prejudice, Young-Breuhl (1996) says, “There is an
elemental anxiety, an inability to tolerate difference, a threat to narcissism
-- 'She (or he) is not like me.’”This
perception of difference is what gives rise to oppressed cultural groups in our
society, and society’s perception of the transgendered as “different” is very
strong.In fact, the transgendered are
“The only group it is still politically correct to mock, and the only group
specifically excluded from the Americans With Disabilities Act.” (Ettner,
1999).

What gives rise to this fear and
societal oppression?According to
Mollenkott (2001), “To many observers, the trans-ing of gender seems like a
wanton removal of all the old landmarks.If crossing gender boundaries erases those boundaries, how will social
order be maintained?”(p. 166).The gender nonconformist is seen as a threat
to the framework of society, the comfortable rules and norms that make us
secure and give us a sense of security and unity.Garber (1992) calls it a “category crisis,” a dissolving of the
borderline that permits “crossings from one (apparently distinct) category to
another:black/white, Jew/Christian,
noble/bourgeois, master/servant, master/slave.”For her, “The notion of 'category crisis,' I will contend, is not
the exception but rather the ground of culture itself." (p. 16).Any group perceived as allowing these border
crossings receives the full brunt of the cultural backlash.

If they let us dance,

Me and my people,

If they let us dance,

Who would lead?(Bornstein, 1995, p. 228)

Considering this cultural backlash,
it is not surprising that “social and economic marginalization frequently
accompanies the transgender experience.” (Israel & Tarver, 1997, p.
19).Transgendered individuals face
high rates of poverty and victimization.“This situation exists because transgender individuals have little societal
support or access to legal recourse, particularly where they are
disenfranchised.”(p. 37).The transgendered are “kept in line” by the
constant public humiliation and threat of violence.“Those who came out of their closets were either studied under a
microscope, ridiculed in the tabloids, or made exotic in the porn books, so it
paid to hide.It paid to lie.”(Bornstein, 1995, p. 8).Thus, Bornstein concludes, “Humiliation is
the whip of the defenders of gender.”(p. 88).

Having been rejected by the
dominant culture, transgender and transsexual individuals have created safe
spaces for themselves, support groups, social groups, even whole communities,
and are engaging in social activism.“Is there a role for the transgendered in this culture?I don’t believe it’s up to the culture to
create such a role.I think it’s up to
the transgendered to claim one for themselves.”(Bornstein, 1996, p. 130).“But now there’s a new generation of transsexuals who are assessing
their journey not as either/or, but rather as an integration, a whole.In bypassing the either/or construct of what
has up to now been transsexualism, these new transsexuals are slipping out from
under the control of the culture.And a
new sub-culture is being born.”(Bornstein, p. 121).

The transgender culture is hard to define.Certainly it varies all over the place.Jan and I have been lucky to be in a location where the local
gay/lesbian/bisexual groups are generally also friendly towards transgender
folks.Jan had her first several
experiences of “going public” at parties given by gay friends.The local transsexual support group is a bit
of a different story.Some are really
messed up and maybe not the people we’d normally choose to socialize with,
although there’s a bond because of being in the same cultural boat.Besides, they are really down on
cross-dressers, and that bothers us.I
guess they think cross-dressers are not quite “the real thing.”I have never had any inclination to go to
any of the support groups for spouses and family.The ones that I’ve been told about seem characterized by much
angst and tears, and I just can’t imagine getting anything useful out of
sitting in a bunch of “Why me?” sessions.I can’t, right at the moment, see myself as being helpful to someone
else in that situation, either.I
wouldn’t have enough patience.

Jan
was lucky to be exposed to a much different transgender community at Esprit
2002, a regional transgender conference she attended last spring.She was lucky (and relieved, I think) to
discover a world of fun, intelligent, successful, and not gender-obsessed
transsexuals, transgenderists, and cross-dressers.It has made a huge difference to find a community where she fits
in, and is proud to do so.She wants me
to go with her next year, and I plan to.Maybe the other partners and spouses will be of the kind who think this
is all just one aspect of life, and not the most important.

Transgender Identity:

Sue and Sue (1999)
propose the use of a Racial/Cultural Identity Development (R/CID) model:

To aid therapists in
understanding their culturally different clients’ attitudes and behaviors.The model defines five stages of development
that oppressed people experience as they struggle to understand themselves in
terms of their own culture, the dominant culture, and the oppressive relationship between the two
cultures:conformity, dissonance, resistance and immersion, introspection,
and integrative awareness. (p. 128).

It is easy to see
transgendered people in and moving through these stages with regards to
transgender identity development.

In the conformity stage, “individuals are distinguished by their
unequivocal preference for dominant cultural values over their own.” (Sue &
Sue, 1999, p. 129).Bornstein (1995)
writes; “most of us assume that there is
gender; that there are only two categories of gender, and that we are (have the
identity of) one or the other.We have
a lot invested in this belief – it’s very difficult to imagine ourselves
genderless.It’s difficult to the degree
that our identities are wrapped up in our gender assignments.We need to differentiate between having and
identity and being an identity.”(p.
117).In this stage, attitudes and
beliefs towards self are self-deprecating, while the belief is that the dominant
culture’s attitudes and social standards are superior.This stage “has a profound negative impact
upon minority groups.”(p. 129).Transgendered individuals, being raised in
a culture that is overwhelmingly prejudiced against them, generally by parents,
who are solidly within the dominant culture, have considerable difficulty
breaking from the conformity stage.According to Israel and Tarver (1997), “In many cases, negative
stereotypes reinforce transgender individuals’ fears, and so their conditions
commonly reach crisis proportions before they seek help.”(p. 33).Sue and Sue also state that attitudes and beliefs towards members of
different minorities in this stage are generally discriminatory.Bornstein, reflecting on the transgender experience
of identity development, writes; “One trouble in having only a few of ‘us’ and
a lot of ‘them,’ is that it’s easy to hit out at the wrong ‘them.’”(p. 82).

I would
also say that the conformity stage “has a profound negative impact” on everyone
around the transgendered person.During
the first few years of our marriage, while John was hiding his transgender
status from himself and everyone else, the struggle came out in confusing and
painful ways; inability to communicate, secrecy, unwillingness to trust, and
constant anxiety.We nearly divorced at
John’s instigation after just one year of marriage.After three-four years, I was the one who was ready to throw in
the towel.But at about the time we
started being honest with each other and together exploring John’s gender
confusion.What a difference our
attempts at understanding, communication and trust have made!

Encountering “information or
experiences inconsistent with beliefs, attitudes, and values held by the
dominant culture” brings about the dissonance
stage.(Sue & Sue, 1999, p.
132).There will be conflict between
self-deprecating and self-appreciating attitudes and beliefs.As Bornstein (1995) describes it for
transgender experience; “if we can’t call the freaks names anymore because we
realize we’re one of them, then we have to look back at our position as a
former insider, and we begin to devalue that.”(p. 81).This stage also encompasses growing suspicion and distrust of dominant
group values.Transgendered individuals
will start asking questions, such as; “I am forced to wonder whether our
culture’s concept of sexual normalcy, which defines the sex organs of as many
as 4 percent of newborn infants as ‘defective,’ is not itself defective.”(Chase, 1993).

In the resistance and immersion stage, the “individual tends to completely
endorse minority-held views and to reject the dominant values of society and
culture.”(Sue & Sue, 1999, p.
133).Consider the experience of John
Stoltenber, who says; “If you look at all the variables in nature that are said
to determine human 'sex,' you can't possibly find one that will unequivocally
split the species into two. … 'We are … a
multisexed species.'I first read
those words a little over ten years ago – and that liberating recognition saved
my life."(As quoted in Davies
& Haney, 1991, p. 147).There may
be feelings of guilt and shame for having formerly endorsed the dominant
culture, coupled with anger at past oppression.Mollenkott, a self-proclaimed gender-transgressor, exhibits this
type of anger when she writes; “The fixed concept of bi-gender complementarity,
with all its freight of male primacy and female subordination, has begun to
collapse because its stake is moving out from underneath.And I for one will be glad to see the conclusion
of the matter.”(p. 36) Bornstein
(1995) shows both the anger and possibility of shame in past participation when
she writes, “The correct target for any successful transsexual rebellion would
be the gender system itself.But
transsexuals won’t attack that system until they themselves are free of the
need to participate in it.”(p. 83).

In many
ways, Jan has gotten beyond this stage, but the anger and defensiveness still
creep in.Sometimes it’s a sharp
rejection of heterosexual “types,” such as when she points out to me, “See what
you could have ended up with?A
football fan with a beer belly and a baseball cap on backwards!”Sometimes it’s an inability to tolerate old
friends’ discomfort, or to believe that they could ever change.Today it was because an old friend was at a
loss over what to tell her 12-year old daughter.Jan told me, “I should have just told her, ‘Good-bye.It was nice being friends for a few years,
but I guess we won’t be friends anymore.’”That hurts.Doesn’t Jan remember
that we too were confused and upset, and maybe even a little phobic, a few
years ago?It took some serious soul
searching for us to change, so mightn’t our friends eventually change too?

During the introspection stage, “the individual begins to discover that this
level of intensity of feelings … is psychologically draining and does not
permit one to really devote more crucial energies to understanding.” (Sue &
Sue, 1999, p. 135).“A need for
positive self-definition in a proactive sense emerges.”The person may also feel discontent with the
rigidity of the resistance and immersion
stage.For Mollenkott (2001), this
involves becoming open to the full range of possibilities.“However much gender-related consciousness
raising has already occurred, it is far from enough.If people are ever going to be free to embody and enact the
precise gender-blend they sense themselves to be, they need to be aware of the
range of human possibilities.”(p.
6).To Bornstein (1995), it is taking
the opportunity to define one’s self.“Gender identity is a form of self-definition:something into which we can withdraw, from which we can glean a
degree of privacy from time to time, and with which we can, to a limited
degree, manipulate desire.”(p. 40).

In the integrative
awareness stage, “minority persons have developed an inner sense of
security and can now own and appreciate unique aspects of their culture as well
as those of U.S. culture.”(Sue &
Sue, 1999, p. 136).There are attitudes
and beliefs of appreciation for self, members of the same and other minority
groups, and selective appreciation of the dominant culture.Bornstein (1995) is comfortable with herself
and playfully challenges the dominant culture when she says, “after
thirty-seven years of trying to be male and over eight years of trying to be
female, I’ve come to the conclusion that neither is really worth the
trouble.And that made me think.A lot of people think it is worth the trouble.And that made me think.Why?Why do people think it’s worth all that trouble to be a woman?And hey, I’m not just talking about
transsexuals here.I’m talking about
men and women, maybe like you.”(p.
234).She is ultimately able to play
with the whole premise that creates her minority status.““I love the idea of being without an
identity, it give me a lot of room to play around; but it makes me dizzy,
having nowhere to hang my hat.When I
get too tired of not having an identity, I take one on:it doesn’t really matter what identity I
take on, as long as it’s recognizable.”(p. 39).

Watching Jan move into this stage has been a delight.Lately, she had taken to wearing her own
hair, grown long, dyed, and fashionably cut, rather than a wig.It’s thin on top, and sometimes people
stare, but now she says, “This is me.Take it or leave it.”And when
people stop and stare, or even laugh and point, she just says, “They must lead
really dull lives to find me so
interesting!”It seems so much
healthier than the days when we were both constantly afraid she wouldn’t
“pass.”

Thus, people who are
transgendered, because of societal prejudice and oppression and because of
their similar experiences and banding together for strength, do constitute a
cultural minority group within the United States.And, the R/CID model is appropriate in describing their identity
development and coincident beliefs and attitudes towards the dominant, their
own, and other minority groups in our society.

Counseling for
the Transgendered

According to Ettner
(1999), “It is safe to predict that every mental health care provider will
encounter at least one transgendered ‘client’ at some point in his or her
professional life.Even if they refer
to a colleague more experienced in this area, it behooves professionals to
understand the nature of gender conditions so that they can act fittingly and
expediently.”(p. 108).If you add in “family, friends and
co-workers,” it is likely the mental-health provider will find transgender
issues a frequent subject of concern in her or his practice.In this section, it is not my intent to
delve into the arena of the “gender specialist.”With Ettner, I urge mental health practitioners to understand
that “therapists who lack experience but opt to work with transgendered clients
bear the professional obligation of seeking consultation or supervision from a
gender specialist.”(p. 109).However, the typical mental health counselor
will have opportunities to work with transgendered individuals and/or their
loved ones on a variety of issues.I
intend to address those things that I believe it is important for any mental
health provider who chooses to work with this population to understand about
transgender issues and how these issues affect the lives of their clients.

Counselor Preparation

“Effective psychotherapy
with transgendered clients flies in the face of much of the conventional
pedagogy intrinsic to counseling and psychotherapy.It requires the clinician to shift paradigms.”(Ettner, 1999, p. 110).“Although it is a cherished canon in
psychotherapy that the therapist allow the client to find his or her own
solutions to problems, working with the transgendered often require violating
this precept.Advice-giving, anathema
to traditional treatment, is often essential to helping the client live safely
and comfortably.”(p. 116).“The role of the therapist in helping an
individual with gender-identity disorder is to be very clear about the
physiological and psychological ramifications of the disorder and to serve as a
guide in aiding the individual through the morass of possibilities leading to
his or her own resolution.”(Anne
Vitale, as quoted in Israel & Tarver, 1997, p. 254).“A good therapist must not only be able to
ease the client’s anxiety but also able to educate, support and provide a
variety of professional referrals.” (p. 255).

Before working with any transgendered clients or
counseling on transgender issues, the mental health practitioner should engage
in some personal preparation.At
minimum, “any counselor, in particular one who is going to be dealing with
gender issues with a client, should work through his or her own sex and gender
issues first.”(Miller, 1996, p.
53).According to Ettner (1999), “one
must be cognitively flexible to work with individuals who undergo physical
change that runs counter to deeply ingrained, bedrock beliefs.Such flexibility requires a goodly amount of
personal plasticity on the part of the clinician.”(p. 110).She continues,
“More successful will be those practitioners who are humanistically or existentially
oriented in theory.They will resonate
with the transsexual’s movement toward self-definition.” (p. 111).“Respect and empathy act in tandem to
provide clients with permission to grow and learn while accommodating to their
new gender role.The therapist who
displays such attitudes and incorporates them into the therapeutic process
provides a counter-shaming experience for the client, so essential for
successful life transition.”(p. 112).

Clinicians need to understand the full range of the
continuum of gender dysphoria, and help clients determine where they lie on the
spectrum. They must also educate the client about the nature of the condition
for which they are seeking treatment.(Ettner, 1999).However, Ettner
warns about over-application of the medical model and diagnostic
techniques.And Miller (1996) reminds
us, “Your responsibility, among others, is to teach them how to learn in this situation, not to tell them what they are
about.”(p. 22).Most important is a general understanding
and communication to the client of the full range of human possibility.In the words of Bornstein (1995), “How sad
for a person to be missing out on some expression of identity, just for not
knowing there are options.” (p. 51).According to GIDreform (2002), “It is time for culturally competent
psychiatric policies that recognize the legitimacy of cross-gender identity and
yet distinguish gender dysphoria as a serious condition, treatable with medical
procedures.”Above all, “scientific,
medical, and mental health professionals are strongly discouraged from
portraying transgender individuals or transgender-associated experiences,
feelings or thoughts as pathologically diseased, mentally ill, deviant, or in
any other manner that exacerbates marginalization of the transgender individual
within social, medical, and mental health infrastructures.”(Israel & Tarver, 1997, p. 20).

The HBIGDA (2001) Standards of Care are a good place
to begin an education about gender issues.Israel and Tarver (1997) provide another excellent resource.They recommended (for the gender specialist,
but I advocate also for anyone working with this population):

Your client may
also bring you numerous resources and insist that you prove adequate
preparation (this population has good reason to be suspicious of the mental
health profession – see section on History).Jan went to her first session with a counselor armed with Miller (1996),
Israel & Tarver (1997), and Ettner (1999), at a minimum, and quizzed the
counselor about her preparation and previous experience with gender confused
clients.They continue to share
resources and discuss current research and recommendations.I wish more people undergoing mental health
counseling were as active on their own behalf because, unfortunately, not all
counselors are as well prepared and willing to learn.

The therapist must be able to
distinguish between gender problems and other concerns, and understand the
interaction between them.Not all
transgendered clients will be seeking counseling for gender problems, nor will
everyone with gender concerns perceive them as the reason for seeking
counseling.“Gender problems are so
central to formation, regulation, and defense of self that they should also be
addressed and acknowledged at the very outset of treatment.”(Ettner, 1999, p. 113).Ettner goes on to cite examples of the error
of working on gender problems last, after other issues, as the other issues are
often related to or a result of the gender issue.“Many other seemingly intractable problems the client faces (including
some Axis I and Axis IV factors) ‘dissolve’ when the client confronts the
gender issue with a trusted and supportive ally.”(p. 113).“Parallel
issues commonly accompany and mask gender-identity concerns.”(Israel & Tarver, 1997, p. 32).On the other hand, “ Sometimes people think
they’re coming to counseling for a gender problem when they actually have other
dysfunctions that need attending to.They procrastinate or they keep losing their jobs or they have no
friends, and they blame it all on their gender issues.”(Miller, 1996, p. 28).Miller advocated the use of role-playing and
dream work to help clarify the issues and understand their origins.

Finally, “Individuals experiencing
concerns about their gender identity may suffer social isolation, emotional
anguish, distorted self-image, and even misdiagnosis by health
professionals.”(Israel & Tarver,
1997, p. 21).Having been abused at the
hand of “the system,” the individual may require a more active advocate than
conventional counseling methods dictate.Both Ettner (1999) and Bornstein (1995) recommend that the client be
advised to consider a range of strategies and options.For Ettner, “The therapist is proactive in
creating an alliance with the client and is willing to be an active, even
nurturing participant in such a venture.”(p. 112).

Barriers to Effective Counseling

Until recently, most transgender care was offered by
university based gender clinics, a system that did not always result in the
best care.“Transsexuals correctly felt
put upon by having the access to their medical care controlled by opinionated
researchers.Academic physicians and
psychologists were often more interested in validating their own theories of
the etiology of transsexualism than in helping transsexuals to live happier
lives.Transsexuals learned to alter
their own life stories to better match the pathologic model favored by the
institution to which they were applying for their medical care.”(Joy Diane Shaffer in forward to Israel
& Tarver, 1997, p. xi).Clients
learned to look upon their counselors as “gatekeepers,” controlling their
access to needed medical therapies.“The ‘gatekeeper’ function refers to the client’s need for referral
letters from the therapist for hormone therapy and, eventually, Genital
Reassignment Surgery.Given their
desire for these letters, the clients are ready, if need be, to take on the
therapist in a battle of wits.” (Anne Vitale as quoted in Israel & Tarver,
p. 251).Although the practice is
moving away from the adversarial approach, Israel & Tarver remind us, “As
professional organizations move toward the depathologization of gender-identity
issues, it is important that professionals and consumers be aware that these
changes (as well as the acceptance of them) are not likely to be uniform.”(p. 24-25).

Even the 1995 Kirk and Rothblatt guide assumes the
counselor will use a somewhat adversarial approach.“The mental health-care professional on the other hand, while
posing as an obstructionist in order to search out and clarify, should in time
add therapy and support as well as direction to the interchange between the
two.I know of counselors who continue
to place one impediment after another even when the tests and examinations
clearly indicate the client is on the correct path.”(p. 3).Although they say,
“The professional is not your enemy, even when you fell that this might be
so”(p. 6), it is easy to see that the
client may approach a new therapist with some trepidation.Trust may be difficult to establish.

Prior negative experiences are also not
uncommon.For Israel and Tarver (1997),
“at the heart of the issue of supporting transgender individuals is the premise
that psychiatrists, psychotherapists, and mental health counselors diagnose and
treat only that which is disordered or diseased.”(p. 25).But, often the
“treatment” seems worse than the problem.For Bornstein (1995), “Transsexuality is the only condition for which
the therapy is to lie.”“As a result of
the medicalization of our condition, transsexuals must see therapists in order
to receive the medical seal of approval required to proceed with any gender
reassignment surgery.Now, once we get
to the doctor, we’re told we’ll be cured if we become members of one gender or
another.We’re told not to divulge our
transsexual status, except in select cases requiring intimacy.Isn’t that amazing?Transsexuals presenting themselves for
therapy in this culture are channeled through a system which labels them as
having a disease (transsexuality) for which the therapy is to lie, hide, or otherwise
remain silent.” (p. 62).She has
similar criticism for the treatment of intersexuals.“It’s a fairly common experience being born with different or
anomalous genitals, but we don’t allow hermaphrodites in modern Western
medicine.We ‘fix’ them.”(p. 57).

Obviously, the therapist should encourage the client
to talk about other experiences in therapy and their assumptions about the
process, and should not be surprised if she or he has to earn the clients
trust.

I knew for a time back in the late 80’s or very early 90’s a gender
specialist who had a large number of transsexual clients.One time he admitted to me, and a small
group of friends, that he thought ALL of his transgender clients were crazy.He said that he didn’t think it was possible
for a transsexual to be well adjusted and mentally healthy.I was appalled.If the professionals that purport to be transgender advocates are
contemptuous, to whom can the transgenderd go?If John/Jan and I waited too long to go for counseling in our journey, I
can only point to this experience.Trust was a long time in coming.

Common Needs and Concerns of the Transgendered

“According to Israel and Tarver
(1997), “The most common mental health issues transgender persons experience
are depression as well as adjustment, anxiety, personality, and posttraumatic
stress disorders.”(p. 40).While the transgender state itself is not
any longer considered to be unhealthy, the stress of dealing with the confusion
and society’s negative response can lead to numerous other problems.One common tactic is denial.Ettner urges that the therapist is
responsible for “educating clients early on that denial is never a healthy
option for living with the condition.” (p. 115).Additionally, transgender persons are no more or less prone to
disfunctionality in their relationships than the general population.“Dysfunctional patterns learned in the
family and other places are brought into the current situation and affect the
way a person deals with the gender issue.But they usually don’t have to do with the actual gender behavior
itself.”(Miller, 1996, p. 49).“A big challenge for the counselor is to
make sure that dysfunctionality issues are worked on and separated from the
gender issues.”(p. 99).

Guilt and shame may be
problems.As mentioned previously and
stated so well by Bornstein (1995), “humiliation is the whip of the defenders
of gender.” (p. 88).Ettner (1999)
stresses the devastating effect of shame on the development of a positive
identity.The lack of positive role
models and sensationalized stories of cross-dressers and transsexuals on TV
talk shows and in the news serve to reinforce the shame and raise the barriers
to seeking counseling.Guilt arises
because many, if not most, transgendered persons inextricably involve others in
their often-painful search for a positive approach to life: partners, parents,
other family and friends.“Guilt over
‘damage,’ or perceived damage, done to others is often expressed in therapeutic
situations and thwarts realistic decision making.”(Ettner, p. 104).Researchers Schaefer and Wheeler (as cited in Ettner) identified guilt
as underlying a host of psychological problems facing the gender-variant
individual.

Some people try amazing things to produce both guilt and
shame in people who are different.Our
Episcopal church has, in general, been amazingly supportive of our
journey.But not everyone in it has
agreed with the supportive approach.First, there came the anonymous letters telling us how perverted we were
and how sickening to others to have us around, telling us we needed to leave
the church or there would be no church left.When that didn’t scare us away, a few of the “dissenters” conducted a
door to door campaign asking all the parents in the church if they weren’t
frightened to send their children to a place that allowed a man to come to
church in a dress.The priest and
vestry heard of this, tried to respond with education on transgender issues,
and also responded with an announcement in the bulletin and church newsletter
that all are welcome at our church
and we have no dress code.In a final
attempt to humiliate, before leaving for a more conservative parish, one church
member demonstrated his scorn by attending a baptism and confirmation service,
at which the Bishop was presiding, in nothing but his swim shorts – so much did
he hate the “no dress code” proclamation and object to what he could only see
as “a man in a dress.”

An issue that is
almost a given for transgenderd clients is coping with loss.“This population of clients, more than most
others, are faced with many possible losses in theirlives.”(Miller, 1996, p. 49).Choosing to be openly gender variant, in particular
the transition process for a transsexual, can result in the loss of family and
friends who disapprove or don’t understand.The loss can be particularly traumatic if, as is often the case, the
disclosure or discovery of the person’s transgender status is unplanned.“In many circumstances, being forced or even
choosing to disclose without being fully prepared for what disclosure involves
can have devastating consequences.” (Israel & Tarver, 1997, p. 49).The loss of a job and place in the community
are also very real possibilities.Kirk
and Rothblatt (1995) advise, “You should consider the very real possibility
that you could lose your position.”(p.
127).Even for those people who
successfully chose to keep their transgender status private, there is
loss.“Denied the opportunity to speak
our stories, transsexuals are denied the joy of our histories.”(Bornstein, 1995, p. 127).

I would say there is also a significant loss of social
confidence and comfort.Jan, as John,
spent a decade as an active member of the local volunteer fire department and
rescue squad.As we drive by her old
station house she often remarks, “I wouldn’t be able to do that now.I can imagine how they would react to
me.”Sometimes she says, “It’s funny, I
never used to think about watching the people around me, to see who might be a
threat.I didn’t worry about going
where I wasn’t known.I always felt
confident about being able to handle myself.”In part, she’s just learning what it’s like to be a woman in a man’s world,
but she’s also learning what it’s like to be unacceptably different in this society.She’s been stalked, threatened, and narrowly
avoided being beaten for presuming to be openly transgendered.Even though she passes most of the time,
she’s learned to be always watching, always alert for the next “incident.”Beyond the personal safety issues, there is
the profound loss of unconscious belonging.There’s no longer the general expectation of positive regard or the
comfortable assurance of anonymity in a crowd.

“The matter of
sexual orientation represents an ongoing concern for transgender individuals
and those providing specialized support care, partly because the terms sex,
sexual orientation, and gender identity are interchanged erroneously.”(Israel & Tarver, 1997, p. 43).Ettner (1999) points out society’s inability
to separate gender from sexuality.The
transsexual, raised in this confusion, may need to work out issues of
sexuality.Because questions of both
sexuality and gender identity tend to peak at puberty, Israel and Tarver find,
“Some transgender individuals may not have crystallized a sexual orientation
during puberty, and may feel uncertainty or reexplore their sexual orientation
simultaneously with exploring gender-identity issues.…He or she should be
encouraged to explore these issues without preconceived expectations.” (p.
45).Mollenkott (2001) reminds us,
“Transsexuals are often presumed to be homosexual, but only about half of
male-to-females end up as lesbians.Among females to males, an increasing number identify as bisexual or
gay.But people cannot be sure where
their change of gender may lead them because sexuality can be very fluid during
the transitional time.”(p. 54).

For the transsexual
and transgenderist, the counselor should actively encourage exploration of
expectations.They are often not
realistic.It is a role of the
counselor to make sure that the client doesn’t proceed too far down an
often-irreversible path without adequate exploration of the consequences.“The initial pre-transition evaluation will
be a challenge on occasion and the impediments may be frequent.”(Kirk & Rothblatt, 1995, p. 3).Although the gender specialist will pay
particular attention to this process, exploration of expectations is beneficial
at every stage.For example, “Often the
M-F transsexual fantasizes a beautiful female figure and a lovely lilting
feminine voice, both resulting from hormone use.Be assured, neither will happen.”(Kirk & Rothblatt, p. 23).Thinking ahead to the transition process, the client should be
encouraged to plan for the “real life experience” and all that it will
entail.Kirk and Robhblatt explain that
this experience is “to live, in every sense of the word, in the role of the
cross-gendered, to exchange and experience with all in his or her life with
family, friends, workplace associates, store clerks, everyone – as a member of
the opposite gender.…It is in my view, a must.”(p. 5).A year or more of real life experience will be required before medical
intervention, particularly sex reassignment surgery, by nearly all gender
specialists.Initial real life
experiments, such as cross-gendered experiences outside of work, or during a
vacation, may be useful to help the client prepare and develop realistic
expectations.

The need for
counseling, and for the counselor as advocate, does not disappear immediately
after successful gender transition.Ettner (1999) finds no validity in the common myth, popular with the
media, of mutilating surgery that transsexuals often live to regret.Instead, she finds that research shows post-operative
results are consistent and point to high satisfaction levels.However, she reminds us that many
individuals experience psychosocial difficulties post-surgery and unexpected
problems of acclimating to the new gender role.They may also continue to deal with the aftermath of unrealistic
expectations.As gender specialists
often do not do much long-term follow-up, this is an area where the general
mental health counselor may be a particularly important part of the client’s
support system.

Until recently,
post-transition transsexuals, or transgenderists living full time in the
opposite gender from their biological sex, were encouraged to adopt the gender
roles dictated by society.Kirk and
Rothblatt (1995), in their advice to post-operative transsexuals allow some
place for androgyny, but say to the M2F,“Genetic women in all of their lives have experienced things you will
never know and, in fact, may not be aware. … At work, at a social event, in a
variety of places and times, you may be quite outstanding if you have no
contribution to make to those conversations.” (p. 85).“Genetic females have a built-in capacity to
relate easily and to connect effectively with others.…If you still present
yourself with the typical masculine attitude and thought process, you will fail
in virtually all of your social endeavors.You should have been developing that mystical, feminine approach to all
around you.”(p. 89).And to the F2M they say,“There is no doubt that the masculine
approach to life is what you want.The
aggressive, dominant attitude, the one-upmanship, all of this is
important.”(p. 93).However, as transsexuals become more
assertive and proactive in their own care, a different attitude and an
acceptance for ambiguity are emerging.Mollenkott (2001) notes that often transgendered people enjoy being
neither woman or man and resent society’s attempts to push them into and
either/or choice.Bornstein (1995) is an eloquent advocate of this
point of view, challenging us even in the title to her book, Gender
Outlaw:On Men, Women, and the Rest of
Us.She
says, “Transsexuals and other transgendered people are finally sitting down,
taking stock, comparing notes – and it’s the dominant culture that’s coming up
short.Some of us are beginning to
actually like ourselves and each other for the blend we are.Many of us are beginning to express our
discontent with a culture that wants us silent.”(p. 64).

Jan is showing the beginnings of
becoming a “gender outlaw” herself.After Esprit 2002 she came home with a bold new attitude.It was exhilarating to see people
comfortable with who they were, rather than always trying to adopt the outward
signs, “perform the gender,” society dictates.She told me that after seeing trans-women carrying themselves with
dignity who had little or no hair, with her wig she began to feel “fake.”Now, as far as she’s concerned, it’s ok to
have a bald spot and receding hairline with hair that is cut, dyed and arranged
in a nice, feminine style.And, she
doesn’t feel like she has to layer make-up on an inch thick to hide every
possible trace of her remaining beard.It’s nice to pass, fun to dress up to the hilt, ok to modify her voice
to sound more feminine, but it’s no longer required.She’s discovered that if people don’t react
well to a very feminine person with a bald spot and deep voice, it’s really
their problem, not hers.I find it not
only a healthier attitude, but also a lot easier on the companion!It’s easier on both of us than the constant
pressure of maintaining the fiction.Referring again to Bornstein who complains, “Transsexuality is the only
condition for which the therapy is to lie.”(p. 62), Jan and I are finding that trying to live a lie is not emotionally healthy.

The collective voice that transgender activists are
beginning to develop emphasizes the need for a feeling of community – that
knowledge that others share your particular viewpoint and experience similar
joys, challenges and concerns.Most transgendered
individuals benefit from a support group or from group counseling.Cross-dressers, in particular, are often
closeted from family and feel isolated and alone.“Many cross-dressers feel bad about their cross-dressing;
consequently, the International Foundation for Gender Education (IFGE) urges
them to join one of the support groups available all over the United
States.According to the IFGE, the urge
to cross-dress ‘may be hard-wired into the brain.It will not go away.Unless you face your feelings, denial will cause frustration, anger, and
depression.’” (Mollenkott, 2001, p. 60).Most areas have transgender support groups.In many urban areas, there are separate support groups for the
cross-dresser, the transsexual, for partners, and for a number of other related
but specific populations.However, some
people won’t feel at home in a support group, and shouldn’t be required to
participate if they find no benefit.The novel Trans-sister radio
(Bohjalian, 2000) gives a very realistic presentation of a transsexual going
through the process of transition, and in this case presents a person who feels
completely out of place in the only support group available.If support groups don’t work, other support
networks should be explored.The
transgendered individual should be encouraged to seek out trans-friendly
businesses and individuals in their community or workplace who can provide that
needed psychological boost and assistance in negotiating the minefield of daily
life.They do exist, in every
community.Find one, and others come out
of the woodwork.But, never let your
client think that it’s possible to “go it alone.”

Ultimately, the counselor should encourage in the
client the skills of self-help and self-understanding.The transgendered will face a life-long
challenge of being “different,” and of having to cope with an ever-varying
array of challenges.They need to
become confident with their ability to assess situations and make
decisions.For Bornstein (1995), this
meant asking a lot of questions and making sure she got the answers.“Before going through with my surgery,
before creating myself in Third, I asked questions, as many as possible, as
many as I could think of.And I wrote
down all the questions that people asked me.Before creating a Third space, it might be a good idea to make sure that
all the questions that need asking actually get asked, as many as
possible.”(p. 98).

Common Issues and Challenges Facing the
Transgendered

Besides the emotional needs and common concerns of
the transgendered, there are a number of specific issues in society that this
population will likely face.The
counselor should be aware of these issues and prepared to help the client with
these challenges.

The all-encompassing issue is
simply that society is not friendly to transgressors of binary gender.Ettner (1999) warns against ignoring the
social pathology that emerges.Gender
conditions arouse intense societal response and real oppression.Bornstein (1995) describes this pathology in
terms of the imperative of “passing.”“Most passing is undertaken in response to the cultural imperative to be
one gender or the other.In this case,
passing becomes the outward manifestation of shame and capitulation.”(p. 125).“There is most certainly a privilege to having a gender.Just ask someone who doesn’t have a gender,
or who can’t pass, or who doesn’t pass.When you have a gender, or when you are perceived as having a gender,
you don’t get laughed at in the street.You don’t get beat up.You know
which public bathroom to use, and when you use it, people don’t stare at you or
worse.…Passing by choice can be fantastic fun.Enforced passing is a joyless activity.”(p. 127).“The fear of being read as transsexual weighs so heavily on an
individual that it focuses even more attention on ‘passing.’” (p. 128).Mollenkott (2001) reminds us, “Even people
with a transgender core identity have been socialized to prefer binaries and to
fear difference – so they must combat not only society’s violent repudiation of
themselves, but the own terror of one another.” (p. 66).

A direct result of society’s gender pathology is the
issue of safety for the transgendered.Many are not aware or adequately prepared.Quite possibly the most useful thing a counselor can do for a
transgendered clients is help them become educated about safety risks and urge
that they learn techniques for self-preservation and self-defense.No other counseling or coping technique will
have any validity if the client does not live to try it out.“The intersexual or transgendered person who
projects a social gender – whatKessler
calls ‘cultural genitals' – thatconflicts with his or her physical genitals still may die for the
transgression."(Fausto-Sterling,
2000, p. 23).Israel and Tarver (1997)
state that rape is a common problem.“One characteristic that places MTF transgender individuals at a high
risk of victimization is that they typically have not been conditioned to guard
against misogynistic sexual violence from an early age.” (p. 37).We need only to look at the paper regularly
or watch the news to know that this is true.

Two transgender teenagers,
best friends who were biologically male but dressed and lived as women, were
shot and killed early yesterday in Southeast Washington -- a crime that police
said was unusually violent and has left them with few leads.(Fahrenthold, 2002)

Jan went alone one Halloween night to a bar that was
having a costume party.While “reading”
her for a guy, it became obvious to some young and macho customers that she was
too “good” to be simply in Halloween costume.Shortly after returning from the men’s room, another customer at the
bar, with his wife, struck up a conversation with Jan.After initial pleasantries, they indicated
that when she was ready to leave for the evening they would like to escort her
to her car.Jan assured them that it
wasn’t necessary and that she didn’t want to inconvenience them.They told her it was indeed necessary.The man had just overheard that group of
young thugs in the men’s room making plans to “follow that cross-dresser out to
the parking lot and teach him a lesson he wouldn’t forget.”

Jan is surprised I even
remember this incident, but it’s not the kind of thing I’m likely to
forget.Neither the fear of violence
nor enduring its aftermath is limited to the transgendered individual.I don’t want to lose her.

Beyond safety, another direct result of society’s
gender pathology is abuse.While abuse
isn’t limited to intersexuals, they are particularly prone to abuse as children
through being denied any choice in the major decisions made about their
future.“Surgical and hormonal
treatment allows parents and physicians to imagine that they have eliminated
the child’s intersexuality.Unfortunately, the surgery is immensely destructive of sexual sensation
as well as one’s sense of bodily integrity.Because the cosmetic result may be good, parents and physicians
complacently ignore the child’s emotional pain in being forced into a socially
acceptable gender.The child’s body,
once violated by the surgery, is again and again subjected to frequent genital
examinations.Many ‘graduates’ of
medical intersex corrective programs are chronically depressed, wishing vainly
for the return of body parts.Suicides
are not uncommon.Some former intersexuals
become transsexual, rejecting their imposed sex.Follow-up studies of adults to ascertain the long-term outcome of
intervention are conspicuously absent.”(Chase, 1993).

Transsexuals and transgenderists who take hormones
need to be aware of the emotional and psychological effects of the medical
treatment they receive.“Individuals
who are initiating hormone administration frequently are poorly prepared for
the emotional changes that go with it.”(Israel & Tarver, 1997, p. 43).Israel & Tarver also point out that, because of the considerable
expense and refusal of most insurance companies to provide coverage, they are
frequently exposed to hormones of questionable quality, and with no medical
supervision, via the black market.They
may be also vulnerable prey for irresponsible practitioners.Gender identity clinics can help clients
negotiate some of the medical/psychological issues.Kirk and Rothblatt (1995) believe they pose an advantage for the
client because all the team will be there, in one place, able to consult with
each other.But, Israel & Tarver
and others applaud the closing of most gender identity clinics.They feel they perpetuate old myths of psychopathology,
and tend to treat clients from that particular clinic’s thesis about the origin
of transgender phenomena rather than stressing what’s best for the client.Medical issues are not limited to hormones
and surgery.Ettner (1999) reminds us
that many gender-variant clients will have attendant depression, which may
require pharmacological management.Consulting with a physician who is comfortable with gender variant
clients is important.

Workplace issues and other legal issues are major
concerns.Counselors may be asked to,
or should in some cases volunteer to, consult with employers and co-workers to
help explain gender issues or the process of transition.“When you transition on the job, it’s wise
to consider the possible need of a conference between your mental health-care
professional and your employer.”(Kirk
& Rothblatt, 1995, p. 128).The
client may have to negotiate employer requests for a transfer in association
with transition, or may wish to request a transfer, assuming that the client
doesn’t outright loose his/her job over being openly transgendered.Or, the client will have to work with
supervisors and company equal employment officers over conditions for
transition on the job.Beyond the
workplace, the client may have to negotiate the multivariate world of legal
documents.Drivers license, birth
certificate, passport, and many others all require listing gender or sex as a
defining characteristic of the individual.Rules vary about when and whether a person can petition to have that
designation changed.States vary in
laws about name changes.Beyond dealing
with the many legal entities that control the process, the client may need help
dealing with disappointment, which can be profound, when he or she encounters
an immovable roadblock.

“Being originally from Ohio, …” was the way John began
an introductory letter to a new friend many years ago.It seemed, at the time, a clever way to
start a discussion about background and family origin.Little did we know how significant “being
originally from Ohio” would turn out to be.Ohio is one of the few states that will not permit, even after a
complete sex reassignment, the modification of the birth certificate to reflect
the new gender.Without the birth
certificate, it becomes almost impossible to change the passport.Even changing the driver’s license, the most
common form of identification, can be problematic.Since we frequently travel internationally, and it’s becoming
more and more difficult for Jan to “masquerade” as a man, this is going to be a
problem for us for a long, long time.And the laws change so slowly…

“Perhaps the most significant
mental health and social support issue faced by transgender individuals
revolves around the disclosure of one’s transgender status and needs to
others.” (Israel & Tarver, 1997, p. 48).The individual must decide who to tell and how to tell, and may need
work on communication skills in general or specifically tailored to disclosing
his or her transgender status.“Most
non-intimate acquaintances such as coworkers or neighbors do not have a need to
know about the individual’s transgender status.” (p. 51).However, “Most knowledgeable Gender
Specialists are quick to recognize that this secretive process is burdensome
and isolating.”(p. 50).As we have already noted, unplanned or
forced disclosure can have devastating consequences, so the individual should
be encouraged to plan disclosure to all who are likely to need to know or who
are likely to discover through the course of regular interactions.Israel & Tarver suggest the following
basic disclosure tools:

-Reflect on the consequences

-Contemplate how the disclosure will affect others

-Prepare for communicating

-Make an appointment

-Validate the relationship

-Relieve stress by revealing

-Share the facts

-Affirm and respect the other person

-Seal the communication

-Reflect inward

The best way to
jeopardize a relationship is to be coy.Jan really hates to pin herself down.If she’s unsure of the outcome, she will often give hints or play
mysterious.Once she said to an
associate at work (where she has yet to transition), “You’ve noticed that I’ve
been looking different lately?[Meaning
painted nails, shaped eyebrows, disappearing facial hair, androgynous to
somewhat feminine clothes.]Well, if we
go out socially, I’ll be like this – only more so.”The poor man looked quizzically at her, then blushed, stammered,
and quickly switched the subject.I’m
still not sure exactly what he
thought, but he hasn’t been interested in getting back together with us.I had a talk with Jan later about disclosure
and trying to understand things from another’s point of view.Yes, it’s a temptation to protect one’s self
from outright rejection by being vague, but it can be very confusing and even a
little cruel.

Religion, for a client who professes any religion at
all, is likely to be a major issue.Mollenkott (2001), herself a Presbyterian minister, asserts, “Christians
(and religious people generally) offer almost no safe faith-oriented space
anywhere for transgender, gay, lesbian, or bisexual youth to sort themselves
out.”(p. 67).Transsexuals and other openly transgendered
people often face outright repudiation of their stories, and have their nature
questioned as a deliberate choice or even outright defiance.The assertion that this is deliberate social
defiance is at odds with most current research.Studies cited by Ettner (1999), Miller (1996) and others point to
a combination of biological, prenatal and environmental influences.But, rather than accept contemporary
research results, many religious activists propose more research, targeted
towards substantiating pre-determined conclusions based on their particular
convictions.

The Evangelical Alliance
[of England] has published the first official evangelical Christian study and
response to the issue of transsexuality, which calls for a more holistic
response to the treatment of the ‘condition’ without recourse to unnecessary
surgery and falsely raised hopes. The Alliance also calls for a full
independent inquiry into the causes of transsexuality by the Chief Medical
Officer. … But we do maintain that a publicly promoted, determined transsexual
lifestyle is not compatible with Christian profession. (Evangelical Alliance
Voice, 2002).

Mollenkott (2001) urges the religious to take a
softer approach.“To religious people
and perhaps certain other readers, my list of transgender categories may seem
to mix that which people cannot help (such as being intersexual) and
voluntarily chosen behaviors which could be interpreted as deliberate defiance
(such as cross-dressing).But as Israel
writes in a sample disclosure letter, cross-dressing is often ‘necessary to
[an] individual’s self-integration process.Therefore it should not be misconstrued as an attempt to impersonate the
opposite gender or perpetrate wrong-doing.’”(p. 41).However, most religious
transgendered individuals, Christian, Jewish, Muslim or otherwise, can expect
somewhere between a negative reception and outright rejection from their
church.

Dear Paul,

We will pray for your
conversion to the Lord, and a return to manhood.Until a full return is made to your masculinity, we consider you
to have severed your relationships with all of us.(Letter to a M2F client from her family, as quoted in Ettner,
1999, p. 115).

Finally, a situation that is guaranteed to cause
distress and confusion for your transgendered client – the public
bathroom.In what must surely be a
contender for the understatement of the decade, Kirk and Rothblatt (1995) warn,
“Agreeable solutions are often hard to come by.”(p. 136).It must seem
utterly implausible to our European colleagues, but Americans have a collective
paranoia about what Jacques Lacan (as cited in Garber, 1992) calls “urinary
segregation.”There are no Federal laws
dictating the rules for use of public bathrooms, and few state or local laws
exist, but self-appointed “bathroom police” make simply relieving one’s self a
traumatic experience for all but the few who manage to “pass” in every
situation.Recommendations, even from
gender professionals, vary concerning the appropriate room to use.Men’s restrooms can be more physically
dangerous for the transgendered, but women seem much more likely to report the
“pervert” to the manager or to the police.So, there is no acceptable choice.And, when a transsexual is known, that person is often forbidden to use
either the women’s or the men’s
room.“I suppose he [the building
manager] felt I would terrorize the women in their bathroom, and lie in waiting
for the men in their bathroom.Finally, a solution was reached:even though I worked on the 11th
floor of a large office building, I would use a bathroom on the seventh
floor.The seventh floor had been under
construction, but for the lack of funds they simply stopped construction; no
one worked on that floor.Piles of
plaster and wiring littered the floor and pools of water lay everywhere.But there was a working bathroom in the very
back of that floor, and that’s where they sent me.No one ever cleaned it, no one kept it stocked.It was poorly lit and scary.”(Bornstein, 1995, p. 84).

I still find it amazing how
much energy “the bathroom question” takes from our lives.There have been many evenings out at
restaurants when Jan sat counting and timing the women going into the women’s
restroom (or men going into the men’s room, depending on which room she felt
she should use that night), waiting for the right moment to scoot in and have a
reasonable chance of not encountering anyone.One night, she thought she had calculated it right.She almost made it.But, as she was washing her hands in the
men’s room, an elderly gentleman walked in and nearly had a heart attack.In some ways it was humorous, but we both
watched anxiously for him to come out – wanting to know that he was alright.As much as possible, Jan tries to avoid
drinking anything when she knows she’s going to be out, so she won’t have to
use a public restroom.Not only is that
not always possible, it’s not healthy!However, since many of the potential situations border more on the
dangerous than on the humorous side, it’s not “healthy” to have to take the
chance more often than absolutely necessary.

Special Populations

There are several distinct groups that require
special consideration, beginning with partners, family, friends and co-workers
of the transgendered.Disclosure to the
partner and close family is a critical issue.According to Erhardt and Swenson (1999), accidental disclosure or
disclosure by a third party is likely to seriously jeopardize the family
relationship.Yet, this can be the most
difficult disclosure for the transgendered person, because the risk of loss is
so great.Thus, it is not surprising
that “often the clients arrive with a confused or angry spouse in tow.”(Ettner, 1999, p. 70).Miller (1996) recommends, “In counseling a
‘T’ who is in a significant relationship it is very important for you to see
that other person as well.”(p.
15).“One of your jobs as the counselor
is to help these two people to be willing to takes the risks involved in honest
communicating.”(p. 123).Although until recently marriages rarely
survived the decision to transition, she warns,“Beware of deciding how it will come out.Just support each person and the couple in
deciding what is right for them.”(p.
130).Erhardt and Swenson (1999)
describe four typical stages that close family or partners go through after
disclosure:1) Initial anger, pain and
confusion; 2) a stage of denial, and urging the transgendered individual to
change or find a cure; 3) a feeling of being left out, unimportant, that
everything is now about gender; and, 4) for the partner, a questioning of one’s
own sexual identity.(If my husband is really a woman inside,
does that mean I’m a lesbian?)Concerning co-workers, and equally applicable to more casual
acquaintances, Kirk and Rothblatt (1995) have the following suggestions, “Be
prepared for the fact that acceptance of your coworkers will be at different
levels and will take variable lengths of time from one to another.They may also be ambivalent.”(p. 127).“Expect surprise, expect reluctance to accept, even rigidity and worse,
even recrimination.”(p. 130).

It’s frustrating for us that so few transsexual people
have spouses that stayed with them throughout the process.We plan to stay together, but we don’t know
what to expect.Erhardt (as quoted in
Vitale, 2002) is in the process of writing a book about spouses of M2F
transsexuals who do stay with their
partner.She says, “I have been at a
loss because of the lack of resources to offer partners that might answer their
question, ‘how do others feel and how have they dealt with this?’"However, one aspect of this relationship is
sheer fun.When confronted with overly
zealous defenders of heterosexuals-only marriage – the “Take Back Vermont”
people come to mind (When I first saw the signs I thought, naively, that it was
a Native American slogan.It wasn’t.)
–it’s comforting to know that we will
be a legally wed lesbian couple!

Another group that requires special consideration are
androgynes, simply because they are often assumed to be transvestites or
transsexuals and are not.“Androgynes simultaneously adopt the characteristics
of both males and females or else attempt to wear gender-neutral clothing in
order to be identifiable as neither male nor female.”(Mollenkott, 2001, p. 69).“Androgynes should not be expected to conform to transvestite or
transsexual models and should not be urged to seek gender reassignment.” (p.
70).Echoing Mollenkott’s point, Israel
and Tarver (1997) assert, “Neither transgenderist nor androgyne individuals
should be required to conform to transvestite, transsexual, or other
stereotypes or support models.The end
result could be misdirected focus on Genital Reassignment Surgery rather than
integrating their actual gender-identity needs.” (p. 16).

There are also specific drag performing and
cross-dressing populations who have their own needs and issues, and should not
be treated as transgenderists or transsexuals.They are transgendered in the broad sense, because they blend gender
lines and cross social gender boundaries, but they rarely have any desire to
live full time in the gender roles they occasionally adopt.According to Mollenkott (2001), drag kings
and queens are men and women, generally gay and lesbian, who impersonate the
other sex for largely for entertainment purposes, and who often enjoy
flamboyant challenges to sexual stereotypes.Cross-dressers are generally heterosexual men.They ordinarily have a male gender identity but experience the
occasional need to express the feminine side of themselves by dressing as
women.Often, but not always, the
cross-dressing is associated with sexual arousal.For some, cross-dressing is an initial step toward discovering a
repressed transsexual identity, but this is not generally the case.(It’s difficult to conceive of female
cross-dressers, in the sense of defying social gender roles.Women wearing men’s clothes is, for the most
part, socially acceptable and would not bring into question a woman’s gender
identity.Additionally, women who wear
men’s clothes rarely do so for sexual stimulation.)

Intersexuals may or may not have the same needs and
issues as other transgendered people.But, one unique issue that they may face is their attitude toward living
in a binary gendered world, and feelings about having been assigned one of
those genders without being consulted.Mollenkott (2001) refers to the videotape, Hermaphrodites Speak! Produced in 1996 and made available from the
Intersex Society of America, which explores the feelings of Intersexuals
towards the attempts by the medical and psychological establishment to fit them
into societies binary gender expectations.“All [on the tape] agree that they would have preferred to have been
left alone, ‘not helped so much.’” (p. 49).She writes, “Both surgeries and social institutions are utilized to
maintain that binary.The surgeries
amount to intersex genital mutilation, and it seems to me fully as horrible as
the female genital mutilation that occurs in many cultures.” (p. 42).Mollenkott, Fausto-Sterling (2000), Chase
(1993) and others recommend only those medical interventions necessary to save
the life or preserve the health of intersexual infants, and that further
intervention be left until such time as the intersexed individual can be
consulted about preference.

Ettner (1995) as well as Kirk and Rothblatt (1995)
offer some comments about how F2M transsexuals may differ from M2F
transsexuals.Kirk and Rothblatt say,
“The new male seems to make a wonderful adaptation to his new existence.Adjustments to family, loved ones, friends
and the workplace seem to be far easier and much more firmly established than
is often the case for the M-F.”(p.
89).For Ettner, F2M’s respond in
significantly different ways from M2F’s.She says they are generally psychologically better adjusted and better
integrated socially.However, for very
young F2M’s, she finds that puberty, particularly the onset of menses, may
create a crisis.Attempts to remain
androgynous may result in being labeled “lesbian.”She recommends that therapists need to be sensitive to the
developmental and societal forces that collude in keeping F2M identities
hidden.

Children who experience gender confusion are
especially vulnerable.“Because gender
identity conflicts are still perceived as a mental health disorder by
uninformed care providers, today’s transgendered youth still are at risk of
being treated in the same manner gays and lesbians encountered years ago.”
(Israel & Tarver, 1997, p. 135).Ettner (1999) finds that not all children with gender identity disorders
will grown into transgendered adults.Therefore, she finds it imperative that counselors be able to
distinguish gender non-conformity from gender dysphoria.They should be trained in developmental
psychopathology and generally competent in treatment of children and
adolescents.Family therapy and
follow-up is crucial.Parents must be
warned to exercise extreme caution in seeking aversion therapies or radical,
unproven methods.She encourages the
use of support groups for families of children experiencing gender identity
conflicts.Mollenkott (2001) suggests
that androgyny be considered as an option for youths experiencing gender
conflict, to give them freedom to explore without committing to a presentation
in either gender role.Israel and
Tarver offer advice on determining whether a child’s gender-identity questions
and exploration are “just a phase” or indicative of special gender issues and
needs.“If there is a ‘cure’ for
children or youth with gender-identity issues, it can be found in the key words
acceptance, androgyny, compromise,
and communication.” (p.137).

Transgender and Other Cultures

The final issue I would like to address concerns the
transgendered in other cultures.I will
explore first how issues of gender nonconformity have historically been dealt
with in non-western cultures, and will then address some of the particular
issues facing transgendered people of minority ethnicity in the U.S.

All societies have gender roles, but the gender roles
are not all the same.Varying greatly
are not only the roles played by men or women, but even the perception of which
attributes are masculine and which are feminine.Mollenkott (2001) shows in detailed analysis that no one
attribute that we think of as “masculine” or “feminine” is universally ascribed
to that gender, not even “masculine aggression.”Bornstein (1995) concludes from this, “The possibility missed by
most of the texts prior to the last few years, and by virtually all the various
popular media, is this:culture may not
simply be creating roles for naturally-gendered people, the culture may in fact
be creating the gendered people.In other words, the culture may be creating
gender.”(p.12).Into the mix, societies vary in their
acceptance of, and in the accepted place for, intersexuals and transgendered
people.The following are a few
examples:

·“Hijras in India, for example, call themselves ‘neither
men nor women.’Their role in Indian
culture is a spiritual one, presiding over marriages and births.”(Bornstein, 1995, p. 131).“Classified as neither men not women, the
hijras are castrated males who dress in female clothing, wear their hair long,
and pluck out facial hair to make their skin as smooth as a woman’s.”(Mollenkott, 2001, p 145).

·“In Burma…the acault are well known for their cross-gender behavior.”(Mollenkott, p. 142).

·“In north and central Thailand, Buddhist myths or
origin refer to three basic sexes – male, female and hermaphrodite (called
kathoey, an independently existing third sex).Only in the twentieth century did kathoey come to mean a ‘deficient’
male.” (Mollenkott, p. 143).

·Williams (1986) discusses the concept of the Berdache
in Native American cultures – a male who generally takes on the feminine role in
society and possibly also in sexuality.He finds, “the mediator between the polarities of woman and man, in the
American Indian religious explanation, is a being that combines the elements of
both genders.This might be a
combination in a physical sense, as in the case of hermaphrodites.Many Native American religions accept this
phenomenon in the same way that they accept other variations from the
norm.But more important is their
acceptance of the idea that gender can be combined in ways other than physical
hermaphroditism.”(p. 21).

·“The Hawaiian language contains no female or male
adjectives or articles, and even proper names are androgynous.This reflects the Polynesian emphasis on
integration and balance of the male and female gods.The notion of gendered polarity – of opposite sexes – is foreign
to Hawaiian thought.”(Ettner, 1999, p.
6).

·Leslie Feinberg, as quoted in Mollenkott, mentions
African spiritual beliefs in intersexual deities and sex/gender transformation
among followers.Mollenkott gives as an
example, “Among the four Bantu-speaking societies, Transgenderism is closely
associated with religious authority, prophet-status, and spiritual
healing.He-Shes or men-women are
perceived to be especially powerful because they combine masculine and feminine
powers just like the original creative deity.”(p. 137).

·Even for Islamic countries, Mollenkott points out that
“during Islam’s first century, for a period of several generations, a group of
male musicians called mukhannathun (‘effeminates’) held a social position of
exceptional prestige and visibility.” (p. 149), and that in Oman, “xaniths or
khanith perform a function similar to that of the hijras of India, although the
xaniths are not castrated.” (p. 150).

Unfortunately, a history of acceptance in
representative cultures worldwide has not, in general, created a modern,
tolerant society.Negative attitudes
towards the transgendered have either been absorbed from the western culture,
or in some cases adopted in reaction to western tolerance.Mollenkott (2001) reports that between 1920
and 1950, Gandhi and Nehru did everything they could to eradicate from Hindu
and Indian culture all positive references to transgenderism and same-sex desire.Gandhi even sent his devotees to 11th
century Hindu temples to destroy carvings of same-sex coupling, in an attempt
to convince people that any queerness in India was entirely the result of
European or Western influence. She also refutes, and cites the damage done by,
frequent modern-day assertions that gender-variant behavior was unknown outside
of Africa until introduced by westerners.And again, in the Islamic world, “The oppression of homosexuals and
transgendered people was increased exponentially after the rise of Islamic
fundamentalism during the late 1970s.” (p. 148).

In the U.S., “the odds are badly stacked against
those who are easily identifiable as members of ‘dual minorities.’” (Israel
& Tarver, 1997, p.125).Gender-specific roles may be more pronounced in ethnic minorities.Sue and Sue (1999) assert that Asian
families may be more hierarchical and have strict gender-specific roles (p.
262), and tell us that Hispanic families often experience conflict over
traditional sex-roles.(p. 293).Tolerance for gender confusion may be less
in such cultures.An individual may be
accused of betraying her or his ethnicity as well as of transgressing the norms
of the broader culture.That same
individual may encounter racism in the transgender community.“Just as there is certain to be transphobia
among individuals of any race, it is essential to recognize that racism exists
within the transgender community.” (Israel & Tarver, p.129).Rather than finding solidarity within one
minority group, the individual may be doubly on the margins.“The displacement of prejudicial commentary
from one embattled minority onto another, the desire to scapegoat another
vulnerable group so as to assuage one's own pain and vulnerability, is a
familiar and dismaying move; it is also, self-evidently, a sign of what we have
been calling 'category crisis' at its rawest and most disturbing."
(Garber, 1992, p. 270).

Israel and Tarver remind us, “Culture and race must
be viewed as having equal importance to an individual’s identity and
presentation.” (p. 128).Just as it’s
important that the counselor be educated about transgender issues and
knowledgeable about needs and life experiences, so is it important for the
counselor to be culturally competent.“The greater the difference between the degrees of acculturation of the
care giver and the consumer, the greater the need to inquire about and
negotiate cultural differences.” (p. 126).Ideally, the client would benefit from a counselor of the same
ethnicity.

While it’s frequently not possible to convene a sizeable group of
transgendered individuals from a specific minority ethnicity, it seems very
helpful when it does happen.At Esprit
2002, Jan became an honorary member of the informal “Asian T-girls” group.(Jan speaks Japanese and is a student of
Japanese culture and tradition.)The
importance of having other Asians to confide in about transgender issues seemed
enough that several individuals put in many extra hours of effort and, even
when they could ill afford it, extra dollars to make it possible for a “critical
mass” of Asians to gather.Immediately
after the 2002 conference, they began work on retention and recruiting of Asian
T-girls for next year. It seemed the sense of doubly belonging, after years of
being doubly in the minority, was critically important.

Final Thoughts

Traveling
through “Genderland” with my partner not been easy, but has been an
enlightening and freeing experience.I
did not choose this path, but, nevertheless, I am the spiritual and emotional
benefactor of Jan’s “huge desire” for honesty and integrity. Thank you, Jan,
for showing me a world of amazing diversity, unique beauty, strong survivors,
and generosity in the face of overwhelming obstacles.

Writing this paper has also given me the pleasure of reading the words
of some remarkably gracious, knowledgeable, kind, and above all, hopeful
people.I’d like to close with a few of
their words – words that helped me hope too.

“I predict that
eventually those with the ‘huge desires’ to be authentic will emerge as the
sanest people in a world that has become obsessed with gender conformity.”
(Mollenkot, 2001, p. 165).

"Sometimes people
suggest to me, with not a little horror, that I am arguing for a pastel world
in which androgyny reigns and men and women are boringly the same.In my vision, however, strong colors coexist
with pastels.There are and will
continue to be highly masculine people out there; it's just that some of them
are women.And some of the most
feminine people I know happen be men."(Fausto-Sterling, 2000, p. 23).

"Hope.It was not that I expected it to alter
radically the nature of my living, but rather that it put me actively into a
context that felt like progress."(Audre Lord, as quoted by Davies & Haney, 1991).

You are welcome to submit your essays for consideration for this
series. Send them to lcrew@newark.rutgers.edu
Identify yourself by name, snail address, parish, and other connections to
the Episcopal Church. Please encourage others to do the same.